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Clin Med - Cardio II > Tachycardia > Flashcards

Tachycardia Flashcards

1
Q

people that present with tachycardia and heart palpitations should get what test

A

12 lead EKG

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2
Q

what is narrow complex tachycardia

A
  1. sinus tachycardia
  2. AV nodal re-entrant tachycardia
  3. AV reciprocating tachyc ardia orthodromic
  4. multifocal atrial tachy
  5. atrial fibrillation
  6. atrial flutter
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3
Q

what is wide complex tachycardia

A
  1. AVRT - antidromic - WPW
  2. ventricular tachycardia
  3. ventricular fibrillation
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4
Q

etiologies of sinus tachy

A
  • exercise
  • ansxiety
  • pain
  • exposure to stimulants (caffeine)
  • volume depletion (dehydration/sepsis)
  • anemia
  • hypoxia
  • hyperthyroidism
  • pulm embolism
  • pericarditis
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5
Q

symptoms of sinus tachy

A

asymptomatic
heart palpitations
SOB (esp with exertion)

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6
Q

symptoms of sinus tachy in pts with heart dz

A 
heart palpitations 
SOB
chest discomfort
lightheadedness
fatigue
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7
Q

treatment of sinus tachycardia

A

treat underlying cause:

  1. dehydration - IV fluid
  2. pain - pain meds
  3. pulm embolism - anticoagulants
  4. sepsis - treat source
  5. anxiety - consider anxiolytics

**No specific treatment for the tachycardia itself

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8
Q

what is supraventricular tachycardia

A
  • regular, rapid rhythm
  • narrow complex (originates above ventricles)
  • no discernible p waves
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9
Q

examples of supraventricular tachycardia

A

atrioventricular nodal reentry tachycardia
orthodromic AV reciprocating tachycardia
junctional tachycardia

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10
Q

symptoms of SVT

A
  • sudden onset racing heart palpitations
  • lightheadedness, pre syncope, syncope
  • SOB
  • anxiety
  • if underlying heart dz: chest pain
  • often self limiting, ends abruptly as well

begins suddenly and ends suddenly

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11
Q

management of persistent SVT stable pts:

A
  • vagal maneuvers
  • carotid massage (listen for bruit, risk of stroke esp >50yo)
  • adenosine (initial dose 6mg IVP, then 12mg IVP, then 12mg IVP)
  • CCB or BB
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12
Q

tx for pts with frequent attacks of SVT

A

consult EP –> confirm aberrant pathway –> radiofrequency catheter ablation

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13
Q

management of persistent SVT unstable pts:

A

vagal maneuvers then if unsuccessful immediate DC cardioconversion

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14
Q

what is DC & how does it work

A

direct cardioconversion

  • medical procedure which converts cardiac arrhythmias to normal sinus rhythm using electricity
  • two electrode pads are placed on the pt (chest and back)
  • electrode pads are connected to a machine via cables
  • the cardioverter delivers a shock which causes momentary depolarization of most cardiac cells allowing the sinus node to resume normal pacemaker activity
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15
Q

what is (AVNRT)

  • which gender more predominant
  • triggered by?
  • HR
A

atrioventricular nodal reentrant tachycardia

  • most common cause of SVT
  • 75% female
  • reentrant circuit around the AV node
  • healthy hearts and sick hearts
  • triggered by exertion, caffeine, alcohol
  • HR 140-280 regular
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16
Q

what is AVRT

A

atriventricular reciprocating tacycardia

  • accessory pathway
  • healthy and sick hearts
  • wide or narrow QRS complexes
  • seen in WPW
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17
Q

tx of stable pts with narrow complex (orthodromic) AVRT

A
  • vagal maneuvers
  • adenosine
  • CCB or BB
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18
Q

if orthodromic AVRT is associated with afib/flutter how would you treat?

A

avoid nodal blocking meds, use class Ia, Ic II antiarrhythmics - procainamide

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19
Q

how would you treat orthodromic AVRT in unstable pts

A

immediate cardioversion

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20
Q

orthodromic AVRT

antidromic AVRT

A
  • orthodromic = narrow complex

- antidromic = wide complex

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21
Q

antidromic AVRT is difficult to distinguish from what?

A

ventricular tachycardia

22
Q

immediate tx of antidromic AVRT: unstable vs stable if you know it’s a preexcitation syndrome

A

immediate DC in unstable pts

procainamide in stalbe pts

23
Q

subsequent tx of antidromic AVRT

A

catheter radiofrequncy ablation of accessory pathway

24
Q

what is WPW

A

-pre-excitation syndrome involving an accessory pathway

25
Q

how many pts are symptomatic in WPW

A

25-50%

26
Q

range of symptoms in WPW

A

palpitations to syncope

27
Q

most common cause of WPW on EKG

A

paroxysmal supraventricular tachycardia which is usually AVRT

28
Q

distribution of people affected by WPW

A

bi modal

  • early childhood
  • early adulthood
29
Q

1/3 of pts with WPW also have

A

afib - potentially serious arrhythmia in WPW pts

  • afib may result in rapid ventricular response
  • subsequent degeneration to ventricular fib = sudden death
30
Q

management of WPW with normal rate and stable

A
  • catheter ablation of accessory pathway (standard of care)

- medical therapy if unable (BB, adenosine, antiarrhythmics - procainamide, amiodarone)

31
Q

management of WPW with fast rate

A

same as other forms of AVRT

  • unstable: DC
  • stable: procainamide
  • subsequent: catheter radiofrequency ablation
32
Q

what is multifocal atrial tachycardia

-therapy?

A 
>=3 p wave morphologies
100-150bpm
-therapy involves tx of underlying medical problems (typically pulm dz)
-verapamil
-flecainide or propafenone
33
Q

what is ventricular tachycardia (sustained)

  • associated with what?
  • rate?
  • complication of what conditions?
A

-fast wide complex rhythm
-often associated with structural heart dz
-frequently associated with syncope
>= consecutive ventricular premature beats
-usual rate 160-240bpm
-moderately regular
-frequent complication of MI and dilated cardiomyopathy

34
Q

symptoms of ventricular tachycardia

A
  • asymptomatic
  • heart palpitation
  • lightheadedness
  • chest pain
  • SOB
  • diaphoresis
  • near syncope
  • syncope
  • sustained LOC
  • pulseless electrical activity (death)
35
Q

tx of acute ventricular tachycardia - pulse present

A

pulse present:

  • if vtach causes hypotension, heart failure, myocardial ischemia = DC
  • if pt is stable = amiodarone 150mg IV bolus followed by continuous infusion
  • implantable cardioverter-defibrillator
36
Q

tx of acute ventricular tachycardia - pulseless

A
  • CPR
  • DC
  • epinephrine
37
Q

what is NSVT

A

3+ consecutive ventricular beats

  • a rate of >120 bpm
  • duration of less than 30s
38
Q

NSVT

  • symptoms
  • how is it found?
  • prognosis in healthy vs structural heart dz
  • potential marker for what?
A
  • common
  • asymptomatic
  • dx on routine EKG or exercise stress test
  • usually benign
  • potential marker for development of sustained ventricular arrhythmias and sudden death
  • in presence of structural heart dz, more serious pronogisis
39
Q

goals of tx for NSVT

A
  • prevent sustained arrhythmia and sudden death

- eliminate symptoms

40
Q

NSVT and associated diseases

A
  • hypertrophic cardiomyopathy - 25%
  • idiopathic dilated cardiomyopathy - 80%
  • valvular heart dz - 20% of pts with MVP, MR, AS
  • chorinc coronary heart dz
  • left ventricular dysfunction
41
Q

management of NSVT

-frequent vs infrequent

A
  1. if infrequent, no specific intervention except:
    - optimize electrolytes, BB, manage underlying conditions/risk modification
  2. frequent: consider amiodarone
42
Q

what is torsades de pointes

A

a type of vtach

43
Q

what is torsades de pointes triggered by

A

hypokalemia, hypomagnesemia, drugs that prolong QTc

44
Q

meds that prolong QTc - antiarrhythmic agents

A

antiarrhythmic agents:
amiodarone
flecainide
sotalol

45
Q

meds that prolong QTc - antipsychotics

A 
chlorpromazine
haloperidol
olanzapine
quetipine
risperidone
46
Q

meds that prolong QTc - antibiotics

A

macrolides (azithro)

quinolones (levo/cipro)

47
Q

meds that prolong QTc - antidepressants

A

citalopram

tricyclic antidepressants

48
Q

tx of torsades de pointe

A

unstable - prompt defibrillation

stable - IV magnesium (1st line); temp transvenous overdrive pacing if no response to magnesium

49
Q

ventricular fibrillation

A

often associated with severe CAD and caused by acute MI (ACS)

  • sudden death may be initial manifestation of coronary dz in 20% of pts
  • pts are pulseless and unresponsive
50
Q

causes of ventricular fibrillation

A
  • myocardial ischemia and infarction
  • heart failure
  • hypoxemia or hypercapnia
  • hypotension/shock
  • electrolyte imbalances
  • stimulants (drugs, caffeine)
  • preceded by Vtach
51
Q

associated conditions with V fib

A
  • LVH
  • HOCM (hypertrophic obstructive cadriomyopathy)
  • CHF
  • AS
  • brugada syndrome
52
Q

tx of v fib

A
  • cpr
  • defibrillation
  • if pulse regained = coronary arteriogrphy , (cardiac cath) to view and tx AAD
  • implantalbe cardioverter-defibrillator

Clin Med - Cardio II (12 decks)

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